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A four-year-old girl died of sepsis two days after she was discharged from A&E, an inquest heard yesterday (November 21).

Despite being rushed to hospital with "red flag" symptoms of the deadly condition, doctors discharged Kessie Thomas with just paracetamol and ibuprofen for her symptoms.

But her worried mother rushed her back to Darent Valley Hospital A&E just two days later when she was dehydrated, vomiting and suffering from diarrhoea.

The unwell youngster was rushed to a specialist children's hospital in London, where doctors battled to save her.

But on April 12, 2017, she was pronounced dead.

An inquest at The Archbishop's Palace, in Maidstone head Kessie, born December 12, 2012, of Main Road, Sutton at Hone, Dartford, had been "inappropriately" discharged when she first visited A&E.

Frothing at the mouth and rolling her eyes

Kessie, originally from Mauritius, was rushed to hospital by ambulance, accompanied by her mum, on April 9.

Dr Anjum said she was told the girl had gone to bed at 8pm that night. Her mum found her at 10pm “frothing at the mouth and rolling her eyes”.

The paramedics who brought her to hospital recorded her temperature as 39.4C and her heart rate was recorded as 177 beats per minute.

Assistant Coroner for North West Kent, Chris Sutton-Mattocks, said that a heart rate above 140 beats per minute for a child of four is a "red flag" for sepsis according to the National Institute for Health Care and Excellence (NICE).

Kessie waited for two hours in A&E before she was seen by Dr Anjum.

Doctors discharged Kessie, 4, with just paracetamol and ibuprofen

'False reassurance'

The doctor said that by the time she was finished examining her Kessie's symptoms had improved – by 2pm her temperature had dropped to 37.8C and her pulse was down to 113 beats per minute.

Dr Anjum said she had considered sepsis as a possibility but told the inquest the child’s apparently improving condition had given her a “false reassurance”.

Kessie's parents’ first language is not English, and the hospital did not have an information leaflet in their first language.

Instead, Dr Anjum said she gave oral instructions of what to watch out for and that she believed the parents understood.

Kessie and her mum, who was not at the inquest, left A&E around 4am on April 10 with paracetamol and ibuprofen to take home.

By the next day her condition had deteriorated, she was vomiting, had diarrhoea, and was dehydrated and lethargic.

At 8.15am her parents brought her back to the A&E at Darent Valley Hospital.

'Inappropriate'

Dr Bharath Gowda, a consultant paediatrician at the hospital, described how the triage nurse made an "inappropriate" assessment, allocating her an urgency level of needing to be seen within two hours.

Kessie needed to be seen much quicker and it had only been because A&E was quiet that she was seen with only a few minutes of arrival.

She was treated at Darent Valley Hospital but it quickly became clear she needed specialist treatment. The Evelina London Children’s Hospital was contacted at 10.10am and an emergency team was dispatched.

Kessie was admitted to the London hospital at 3.15pm.

Dr Joane Perkins, paediatric consultant at the Evelina Children’s Hospital, who treated Kessie, said she had about a 72 per cent risk of death on entry to the hospital.

She said generally children diagnosed with sepsis have a mortality rate of about 10 per cent.

The London hospital treated Kessie and resuscitated her several times throughout the afternoon and evening, but around 9pm it was decided there was little else they could do.

More from the coroners' court

'Was it the wrong decision?'

Dr Gowda was questioned by the coroner as to the decision to discharge Kessie on her first visit to A&E.

“An experienced registrar would admit and observe,” in the same circumstances, he said.

The coroner asked Dr Gowda if there was a chance the girl might have been saved if she had been admitted first time around, to which he responded “yes”.

Asked the same question Dr Anjum said: “We might have tried to save her and the outcome might have been different.

"Perhaps in light of all that happened it would have been more appropriate to have admitted her for a period of observation."

She said she apologised and said she had never seen a child’s symptoms improve like that with sepsis, but when asked by the coroner if she was aware of the red flag criteria of the heart rate over 140 for a child under five, she said "no".

She said: “Since this incident happened my approach has been I always keep the child in and keep them in for 24 hours."

Dr Anjum had worked at the hospital fewer than two months when Kessie was first brought in, and has since left for another trust.

A root cause analysis by the trust read out to the inquest found “admission would have been appropriate,” and a longer period of medical observation was deemed the most appropriate response.

'Potentially preventable'

Paraphrasing For Whom The Bell Tolls, by John Donne, the coroner said: “The death of a four-year-old child diminishes all of us.

“This child’s death, was, in my judgement, potentially preventable.

“Had she been admitted on her first trip to A&E she may have been alive today.”

He said when she was taken to A&E on April ninth, “her sepsis was not identified” and that “there clearly were missed opportunities”.

Addressing her first trip to A&E he said “whether or not a child of four suffering from fits should have had to wait for two hours at A&E to be seen is a matter of conjecture.”

He said he was satisfied that the doctor who discharged Kessie had done so believing it was in the best interests of the child, and he said he was “pleased to see that lessons appear to have been learned”.

He said Kessie “had one of the clear red warning indicators of sepsis” when she first appeared in A&E, and he said on her second visit she was "wrongly" assessed as being able to wait two hours to be seen.

He also noted sepsis does go by the name "the silent killer".

He concluded the cause of death was sepsis, brought on by pneumonia.

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